Autotransplantation In Patients Research Articles

Applying LASSO logistic regression for the prediction of biliary complications after ex vivo liver resection and autotransplantation in patients with end-stage hepatic alveolar echinococcosis

BackgroundThe purpose of this study was to explore the relevant risk factors associated with biliary complications (BCs) in patients with end-stage hepatic alveolar echinococcosis (HAE) following ex vivo liver resection and autotransplantation (ELRA) and to establish and visualize a nomogram model.MethodsThis study retrospectively analysed patients with end-stage HAE who received ELRA treatment at the First Affiliated Hospital of Xinjiang Medical University between August 1, 2010 and May 10, 2023. The least absolute shrinkage and selection operator (LASSO) regression model was applied to optimize the feature variables for predicting the incidence of BCs following ELRA. Multivariate logistic regression analysis was used to develop a prognostic model by incorporating the selected feature variables from the LASSO regression model. The predictive ability, discrimination, consistency with the actual risk, and clinical utility of the candidate prediction model were evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Internal validation was performed by the bootstrapping method.ResultsThe candidate prediction nomogram included predictors such as age, hepatic bile duct dilation, portal hypertension, and regular resection based on hepatic segments. The model demonstrated good discrimination ability and a satisfactory calibration curve, with an area under the ROC curve (AUC) of 0.818 (95% CI 0.7417–0.8958). According to DCA, this prediction model can predict the risk of BCs occurrence within a probability threshold range of 9% to 85% to achieve clinical net benefit.ConclusionsA prognostic nomogram with good discriminative ability and high accuracy was developed and validated to predict BCs after ELRA in patients with end-stage HAE.

Risk and predictors of severe hyperkalemia after total parathyroidectomy without auto-transplantation in patients with secondary hyperparathyroidism.

To identify the risk factors of postoperative severe hyperkalemia after total parathyroidectomy (TPTX) without auto-transplantation in patients with secondary hyperparathyroidism (SHPT). Data on 406 consecutive patients who underwent TPTX without auto-transplantation for secondary hyperparathyroidism at the General Hospital of Northern Theater Command between January 2013 and January 2023, were prospectively collected. Then, patients were divided into the training set (n=203) and the validation set (n=203) in a ratio of 1:1 by timeline. The patients were divided into severe hyperkalemia group and non-hyperkalemia group according to the postoperative serum kalium level >6.0 mmol/L with ECG changes or serum kalium level ≥6.5 mmol/L. Univariate and multivariate logistic regression analyses were used to evaluate the possible risk factors associated with postoperative severe hyperkalemia after TPTX. The predictive performance was evaluated with receiver operating characteristic (ROC) curves with the areas under the ROC curve (AUC) and calibration curve. Decision curve and clinical impact curve analyses were used to validate the clinical application of the value. The incidence of postoperative severe hyperkalemia was 15.5% in all patients, 17.2% and 13.8% in the training and validation cohorts, respectively. The risk factors associated with postoperative severe hyperkalemia was higher preoperative kalium level. The optimal cut-off value for preoperative serum kalium level was 5.0mmol/L according to the ROC curve. The area under the curve (AUC) achieved good concordance indexes of 0.845 (95%CI, 0.776-0.914) in the training cohort. The sensitivities were 0.829 (95%CI: 0.663-0.934) and 0.857 (95%CI: 0.673-0.960) in the training and validation cohorts, respectively. The specificities were 0.798 (95%CI: 0.729-0.856) and 0.720 (95%CI:0.647-0.785) in the training and validation cohorts, respectively. Calibration curve exhibited a good consistency between actual observations and predicted severe hyperkalemia in the training and validation cohorts. Our study found that the preoperative kalium levels is only a risk factor for postoperative severe hyperkalemia in patients undergoing TPTX for secondary hyperparathyroidism. The threshold for preoperative serum kalium levels is 5.0mmol/L that can serve as a useful indicator for identifying patients with severe hyperkalemia after surgery. These results provide valuable suggestion for clinical practice.

A novel remnant liver-first strategy for liver autotransplantation in patients with end-stage hepatic alveolar echinococcosis: a retrospective case series.

Ex vivo liver resection combined with autotransplantation is an effective therapeutic strategy for unresectable end-stage hepatic alveolar echinococcosis (HAE). However, ex vivo liver resection combined with autotransplantation is a technically demanding and time-consuming procedure associated with significant morbidity and mortality. The authors aimed to present our novel remnant liver-first strategy of in vivo liver resection combined with autotransplantation (IRAT) technique for treating patients with end-stage HAE. This retrospective study included patients who underwent IRAT between January 2014 and December 2020 at two institutions. Patients with end-stage HAE were carefully assessed for IRAT by a multidisciplinary team. The safety, feasibility, and outcomes of this novel technique were analyzed. IRAT was successfully performed in six patients, with no perioperative deaths. The median operative time was 537.5min (range, 501.3-580.0), the median anhepatic time was 59.0min (range, 54.0-65.5), and the median cold ischemia time was 165.0min (range, 153.8-201.5). The median intraoperative blood loss was 700.0ml (range, 475.0-950.0). In-hospital complications occurred in two patients. No Clavien-Dindo grade III or higher complications were observed. At a median follow-up of 18.6 months (range, 15.4-76.0) , all patients were alive. No recurrence of HAE was observed. The remnant liver-first strategy of IRAT is feasible and safe for selected patients with end-stage HAE. The widespread adoption of this novel technique requires further studies to standardize the operative procedure and identify patients who are most likely to benefit from it.

MM-317 Non-Cryopreserved Hematopoietic Stem Cells Autotransplantation in Patients With Multiple Myeloma (MM) Aged 65 and Older

MM-317 Non-Cryopreserved Hematopoietic Stem Cells Autotransplantation in Patients With Multiple Myeloma (MM) Aged 65 and Older

241-OR: Preservation of Islet Graft Function and Blood Glucose Control after Total Pancreatectomy with Islet Autotransplantation in Patients with Chronic Pancreatitis and Intractable Pain—Nine-Year Follow-up

Background: Total pancreatectomy is a last resort treatment for patients with chronic pancreatitis and intractable abdominal pain, however its utility has been hampered by the uncertain endocrine outcomes of islet transplantation and risk of postsurgical diabetes. Here, we present our 9-year clinical results after total pancreatectomy and islet transplantation. Materials and Method: Forty-one patients with chronic or recurrent acute pancreatitis were treated with TPIAT over the last 9 years at the University of Chicago Medical Center. There were 15 male and 26 female with a median age of 33 (6-65) and with median BMI of 25 (17-39). Five (12%) patients were already diabetic prior to surgery. Islet isolation was performed at a local laboratory compliant with current Good Manufacture Practice regulations. Islet purification was implemented in 4 (10%) cases to reduce islet pellet volume below 20mL for intraportal infusion. Results: All patients required opioids for pain control prior to surgery. Most of the patients (93%) reported resolution of pancreatic-type pain by postoperative year one. The number of patients requiring opioids for different type or location of pain declined over time from 13 (31%) at 1 year to 5 (12%) at 5 years after TPIAT. During TPIAT patients received on average 211,000±111,000 islet equivalents (IEQ), 2,500±1,600,). The majority of patients (95%) maintained endocrine beta cell function during follow up (serum c-peptide >0.5ng/ml). Over 40% of patients maintained long-term insulin independence: 44% (15/34) at 1-year and 45% (5/11) at 5-year follow-up. Conclusions: TPIAT successfully provided pancreatic pain resolution of pancreatic pain and preservation of the endocrine beta cell function in majority of the patients with no mortality. Islet autotransplantation prevented diabetes in over 40% of patients. Disclosure W.Lin: None. L.Wang: None. M.Tibudan: None. R.Barth: None. J.Fung: None. P.Witkowski: Advisory Panel; Vertex Pharmaceuticals Incorporated, Novartis. M.Ogledzinski: None. S.Gondek: None. K.Milejczyk: None. B.Juengel: None. L.Potter: None. P.J.Bachul: None. L.Basto: None. L.Perea: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (P30DK020595)

Availability of Third Molars as Donor Teeth for Autotransplantation to Replace Congenitally Absent Second Premolars in Children and Young Adults.

The aim of the study was to assess the presence and distribution of third molars (M3) regarding their autotransplantation in patients with congenital absence of second premolars (PM2). Additionally, M3 development in relation to patients' age and gender was investigated. Panoramic radiographs of non-syndromic patients with at least one congenitally absent PM2 were used to assess the localization and number of missing PM2 and the presence or absence of M3 (minimum age 10 years). The alternate logistic regression model was applied to analyze associations between the presence of PM2 and M3. A total of 131 patients with PM2 agenesis were identified (82 females, 49 males). At least one M3 was present in 75.6% and all M3 were present in 42.7% of patients. A statistically significant association between the number of PM2 and M3 agenesis was found; the effects of age and gender were not significant. More than half of M3 in patients between 14-17 years old had completed ¼ of their root development. The congenital absence of maxillary PM2 was associated with the absence of maxillary PM2, M3, and no correlation was found in the mandible. In patients with PM2 agenesis, at least one M3 is often present and can be considered as a donor tooth for autotransplantation.

Risk Factor Analysis and Prediction of Severe Hypocalcemia after Total Parathyroidectomy without Auto-Transplantation in Patients with Secondary Hyperparathyroidism.

Our study aimed to develop and validate a nomogram to predict severe hypocalcemia (SH) before total parathyroidectomy (TPTX) without auto-transplantation in patients with secondary hyperparathyroidism. A total of 299 consecutive patients who underwent TPTX without transplantation for secondary hyperparathyroidism were selected from the General Hospital of Northern Theater Command between January 2013 and December 2021. Of these, patients who underwent surgery between January 2013 and December 2020 formed the training cohort (n = 208) to develop a nomogram, and those who underwent surgery thereafter formed the validation cohort (n = 91) to validate the performance of this nomogram. Univariate and multivariate logistic regression analyses were used to identify the risk factors associated with SH, and then, a nomogram was constructed. The incidence of postoperative SH was 27.9% and 35.2% in the training and validation cohorts, respectively. The preoperative factors associated with SH were younger age, lower serum calcium (Ca) level, higher intact parathyroid hormone (iPTH) level, and higher serum alkaline phosphatase (ALP) level. Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.866 (95%CI, 0.816-0.916) and 0.867 (95% CI, 0.793-0.941) in predicting SH in the training and validation cohorts, respectively, and had well-fitted calibration curves. The positive predictive values of the nomogram were 64.7% (54.1%-78.4%) and 75.0% (58.6%-88.5%), and negative predictive values of the nomogram were 90.0% (82.9%-93.6%) and 86.4% (73.5%-94.0%) for the training and validation cohorts, respectively. We developed and validated a nomogram for the prediction of SH in patients who underwent TPTX without auto-transplantation for secondary hyperparathyroidism. Our nomogram may facilitate the identification of high-risk SH in patients after TPTX and optimization of preoperative decision-making.

Blood pressure control and renal function preservation of exvivo renal artery repair with orthotopic renal autotransplantation for complex renal artery diseases.

To assess the outcome of exvivo renal artery repair with orthotopic renal autotransplantation for patients with complex renal artery disease. The single-center study collected and analyzed the data from patients with complex renal artery disease undergoing exvivo renal artery repair with orthotopic renal autotransplantation, retrospectively. A total of 21 complex renal artery lesions from 19 patients were included. The mean blood pressure showed a significant decrease from the preoperative to the postoperative period (P< .05). Renal function kept stable for the perioperative period. No significant serum creatinine and estimated glomerular filtration rate alteration was observed compared with the immediate postoperative period (P= .439 and .904, respectively). The median renal cold ischemia time was 35.5 (76) minutes. Two patients developed perioperative complications, one with acute cholecystitis and one with acute renal failure after graft occlusion in a solitary kidney. During the median follow-up of 48months, one single bypass graft of a solitary kidney was occluded, and four grafts developed restenosis. The primary and primary-assisted patency rates at the 5-year follow-up were 81.3% and 87.5%, respectively. No deaths were observed in the follow-up period. Exvivo renal artery reconstruction with orthotopic renal autotransplantation in patients with complex renal artery disease offers stable control of blood pressure and renal function preservation, and should be considered as a potential alternative for other open surgical procedures.

Is There a Benefit From Islet Autotransplantation in Patients With Type 1 Diabetes Mellitus Undergoing Total Pancreatectomy?

Children with acute recurrent and chronic pancreatitis (CP) experience abdominal pain that leads to hospitalizations, opioid dependence, and poor quality of life. Total pancreatectomy with islet autotransplantation (TPIAT) is offered as a surgical option in management of debilitating pancreatitis that fails medical and endoscopic therapy to reduce or eliminate pain. Given that patients with type 1 diabetes mellitus (T1DM) lack insulin-producing β cells, the outcomes from autotransplanting islet isolates back into total pancreatectomy patients with T1DM are not fully known.We performed TPIAT in 2 CP patients who also had a diagnosis of T1DM for at least 6 years before the operation and evaluated the clinical and laboratory outcomes before and after the operation. Postoperatively both patients' abdominal pain had significantly subsided, they were weaned off opioid medications, and they were able to return to full-time school attendance. In addition, total daily dose of insulin in 1 patient was able to be slightly reduced at 12 months post-TPIAT. We observed in vitro that residual α cells and β cells in T1DM islets were able to secrete a small amount of glucagon and insulin, respectively.

Methods of carotid endarterectomy

This literature review is devoted to various carotid endarterectomy (CE) methods that exist today in Russia. The pros and cons of conventional and eversion technique of the operation are given. It is indicated that the former is associated with higher long-term rate of restenosis, aneurysm and patch infection. The second is associated with higher prevalence of intraoperative internal carotid artery (ICA) thrombosis due to intimal detachment distal to endarterectomy area. The following CE methods for patients with prolonged ICA involvement are described: neo bifurcation formation, autoarterial reconstruction, ICA autotransplantation, plastic using an occipital artery flap. The methods of CE with carotid body saving have been demonstrated: 1. Swallow tail type patch repair proposed by R.I. Izhbuldin; 2. S-shaped arteriotomy proposed by K. A. Antsupov; 3. Two types of operations proposed by R. А. Vinogradov; 4. Сutting off the ICA with sections of common and external carotid artery proposed by A. N. Kazantsev; 5. Glomus-saving ICA autotransplantation in patients with prolonged atherosclerotic involvement. The role of ICA transposition over the hypoglossal nerve in eversion CE is presented. The glomus-saving CE with ICA transposition, called Chik-Chirik CE, is described. Conclusions are drawn on the need to demonstrate all CE types in the novel Russian guidelines for the management of patients with of head and neck arterial diseases.

Hypoxia stimulates angiogenesis and a metabolic switch in human parathyroid adenoma cells.

Hypoxia, a primary stimulus for angiogenesis, is important for tumour proliferation and survival. The effects of hypoxia on parathyroid tumour cells, which may also be important for parathyroid autotransplantation in patients, are, however, unknown. We, therefore, assessed the effects of hypoxia on gene expression in parathyroid adenoma (PA) cells from patients with primary hyperparathyroidism. Cell suspensions from human PAs were cultured under normoxic or hypoxic conditions and then subjected to cDNA expression analysis. In total, 549 genes were significantly upregulated and 873 significantly downregulated. The most highly upregulated genes (carbonic anhydrase 9 (CA9), Solute carrier family 2A1 (SLC2A1) and hypoxia-inducible lipid droplet-associated protein (HIG2)) had known involvement in hypoxia responses. Dysregulation of oxidative phosphorylation and glycolysis pathway genes were also observed, consistent with data indicating that cells shift metabolic strategy of ATP production in hypoxic conditions and that tumour cells predominantly utilise anaerobic glycolysis for energy production. Proliferation- and angiogenesis-associated genes linked with growth factor signalling, such as mitogen-activated protein kinase kinase 1 (MAP2K1), Jun proto-oncogene (JUN) and ETS proto-oncogene 1 (ETS1), were increased, however, Ras association domain family member 1 (RASSF1), an inhibitor of proliferation was also upregulated, indicating these pathways are unlikely to be biased towards proliferation. Overall, there appeared to be a shift in growth factor signalling pathways from Jak-Stat and Ras signaling to extracellular signal-regulated kinases (ERKs) and hypoxia-inducible factor (HIF)-1α signalling. Thus, our data demonstrate that PAs, under hypoxic conditions, promote the expression of genes known to stimulate angiogenesis, as well as undergoing a metabolic switch.

Long-term Normothermic Machine Preservation of Partial Livers: First Experience With 21 Human Hemi-livers.

The aim of this study was to maintain long-term full function and viability of partial livers perfused ex situ for sufficient duration to enable ex situ treatment, repair, and regeneration. Organ shortage remains the single most important factor limiting the success of transplantation. Autotransplantation in patients with nonresectable liver tumors is rarely feasible due to insufficient tumor-free remnant tissue. This limitation could be solved by the availability of long-term preservation of partial livers that enables functional regeneration and subsequent transplantation. Partial swine livers were perfused with autologous blood after being procured from healthy pigs following 70% in-vivo resection, leaving only the right lateral lobe. Partial human livers were recovered from patients undergoing anatomic right or left hepatectomies and perfused with a blood based perfusate together with various medical additives. Assessment of physiologic function during perfusion was based on markers of hepatocyte, cholangiocyte, vascular and immune compartments, as well as histology. Following the development phase with partial swine livers, 21 partial human livers (14 right and 7 left hemi-livers) were perfused, eventually reaching the targeted perfusion duration of 1 week with the final protocol. These partial livers disclosed a stable perfusion with normal hepatic function including bile production (5-10 mL/h), lactate clearance, and maintenance of energy exhibited by normal of adenosine triphosphate (ATP) and glycogen levels, and preserved liver architecture for up to 1 week. This pioneering research presents the inaugural evidence for long-term machine perfusion of partial livers and provides a pathway for innovative and relevant clinical applications to increase the availability of organs and provide novel approaches in hepatic oncology.

Risk factors affecting graft survival after parathyroidectomy and parathyroid autotransplantation in patients on maintenance hemodialysis

To investigate the risk factors affecting the survival of parathyroid autograft following total parathyroidectomy combined with autologous sternocleidomastoid muscle transplantation (TPTX + AT) in patients on maintenance hemodialysis (MHD) complicated with secondary hyperparathyroidism (SHPT). This retrospective study was conducted among the patients on maintenance hemodialysis with SHPT, who underwent successful parathyroidectomy and autotransplantation from January, 2010 to February, 2020 in our hospital. The clinical data and serum levels of calcium, phosphorus, intact parathyroid hormone, hemoglobin, and alkaline phosphatase (ALP) of the patients were collected. The enrolled patients were divided into survival group with bilateral forearm parathyroid hormone (iPTH) ratio > 1.5 and death group with a ratio < 1.5 at 2 weeks after surgery for comparison of the clinical data and perioperative indicators. The risk factors of postoperative parathyroid autograft survival were analyzed using logistic regression analysis. A total of 87 patients were included in the study, among whom the graft survival rate after parathyroid transplantation was 78.16%. In both groups, serum levels of calcium, phosphorus, iPTH and ALP decreased and hemoglobin level increased significantly at 1 week and 1, 2, 3, 6 and 12 months after surgery (P < 0.01). Logistic regression analysis showed that serum ALP level was an independent risk factor for graft survival following parathyroid autotransplantation [OR=1.003, 95% CI: 1.001-1.005, P=0.004]. TPTX+AT is a safe and effective treatment for SHPT, and parathyroid autografts are less likely to survive following parathyroid transplantation in patients with high preoperative level of ALP.

167-OR: Long-Term Follow-up after Total Pancreatectomy and Islet Cell Autotransplantation in Patients with Chronic Pancreatitis Utilizing Off-Site Islet Isolation

Context: Total pancreatectomy (TP) with islet-cell auto transplantation (IAT) is an option for pain management for patients with chronic pancreatitis (CP). IAT allows the preservation of beta cell function to reduce or prevent long-term diabetes. Objective: We performed a follow-up study up to 12 years after TPIAT surgery with an off-site isolation laboratory, to determine the efficacy and durability of the procedure. Methods: Data (August 2008 to August 2020) were obtained from a TPIAT database which included information from medical records, clinic visits, questionnaires, and follow-up telephone calls. Patient demographics were collected. Additionally, each patient was assessed with a 4-hour mixed meal tolerance test for metabolic measurements, serial glycosylated hemoglobin (HbA1c), and insulin requirements prior to surgery and during their most recent follow-up appointment. Results: Seventy-seven patients with a median age of 45.0 years underwent TP-IAT for CP due to different etiologies. At a median follow-up time of 422.5 days 12 patients were insulin independent and 65 patients were on at least one insulin injection a day. Post-operative C-peptide area under the curve (AUC) measurements (P=0.008) were a better indicator of procedure success compared to the number of islet cells transplanted (P=0.225). Patients who were insulin-dependent post-surgery demonstrated increased insulin resistance prior to surgery, by their median pre-surgery insulin AUC; insulin-independent, 626 (241, 3803); insulin-dependent, 1591 (325, 4803), HOMA-IR values 9.02. Conclusions: TPIAT improves intractable pain for patients with CP. IAT decrease insulin requirement and improve blood glucose control after TP. Insulin resistance prior to surgery may be a predictor for insulin-dependence. Intervention studies using insulin sensitizer prior surgery may be considered in evaluating long-term outcomes for these patients. Disclosure S. U. Lad: None. K. F. Ali: None. P. C. Johnston: None. V. San martin: None. Y. Lin: None. R. Bottino: None. M. Walsh: None. T. Stevens: Speaker’s Bureau; Self; AbbVie Inc. B. Hatipoglu: None.

Use of the ligamentum teres hepatis for outflow reconstruction during ex vivo liver resection and autotransplantation in patients with hepatic alveolar echinococcosis: A case series of 24 patients

BackgroundPatients with extensive hepatic alveolar echinococcosis might require ex vivo liver resection and autotransplantation to remove the lesion. Patients with extensive vascular invasion will need reconstruction, but the selection of the proper graft is complicated. This study aimed to investigate the effectiveness and adverse events of using the ligamentum teres hepatis as a vascular replacement graft in ex vivo liver resection and autotransplantation. MethodsThis was a retrospective case series of patients with hepatic alveolar echinococcosis who underwent ex vivo liver resection and autotransplantation between August 2010 and October 2018 and in whom the ligamentum teres hepatis was used to repair the remnant liver. The operative outcomes, recurrence, and survival were examined. ResultsTwenty-four patients were included (10 men, 14 women). The anhepatic period was 290 to 672 minutes (median of 450 minutes). The ratio of the remnant liver volume to the standard liver volume was 0.43 to 0.97 (median of 0.71). The blood loss was 1,000 (500–5,000) mL. The postoperative hospital stay was 23 (1–85) days. Of the 24 patients, 3 died after the operation, but those deaths were unrelated to liver vascular complications. ConclusionThe ligamentum teres hepatis could be used as a vascular replacement graft in ex vivo liver resection and autotransplantation. It has the advantages of convenient specimen extraction, no donor site injury, and no immunological rejection, which has promising clinical application prospects.

Transplantation and autotransplantation of the liver in radical treatment of unresectable liver tumors and parasitic diseases

Aim. To evaluate results of liver transplantation and ex situ liver resection and autotransplantation in patients with unresectable parasitic and tumor liver lesions. Matherial and methods. A total of 22 orthotopic liver transplants and 4 ex situ liver resection and autotransplantations were performed. Liver transplants performed in 10 cases of unresectable hepatocellular carcinoma, 8 cases of alveolar echinococcosis, 4 cases of hepatic epithelioid haemangioendothelioma. Ex situ liver resection and autotransplantation were performed in 3 cases of alveolar echinococcosis and in 1 case of cholangiocarcinoma. Results. Postoperative complication developed in 38,4% patients. Mortality rate was 19.2%. Patients with alveolar echinococcosis were most complicated group with 36,3% early mortality rate. Mortality in hepatocellular carcinoma group was 10%. There were no early mortality in haemangioendothelioma and cholangiocarcinoma patients. Median overall survival for hepatocelluler carcinoma, alveolar echinococcosis and hepatic epithelioid haemangioendothelioma groups was 48, 36, 20 months respectively. Patient after ex situ liver resection for cholangiocarcinoma alive for 24 months and still disease free. Conclusion. Liver transplantation and ex situ liver resection and autotransplantation is the only opportunity for radical treatment for unresectable alveolar echinococcosis and some oncological diseases of the organ. Patients with unresectable alveolar echinococcosis is a high risk group of postoperative complications due to initial poor physical status, long-time disease, chronically infections and parasitic invasion.

First Ovarian Tissue Cryopreservation and Autotransplantation in Patients with Malignancies in Hungary – Report of the First Three Cases

Fertility Preservation, Cryopreservation, Ovarian Tissue Autotransplantation and Malignancies. Abstract: Autotransplantation of cryopreserved ovarian tissue is one of the most advanced methods for fertility preservation of patients suffering from malignant diseases. Even though the method itself is still experimental, nearly a hundred live births have been documented worldwide, and its efficacy is comparable with the efficacy of any other assisted reproductive technology. Our prospective, nonrandomized study was the first in Hungary that aimed to examine the safety and efficacy of fertility preservation based on ovarian tissue cryopreservation and autotransplantation. Patients were included only with stage I-III malignancy confirmed by histological diagnosis with a high risk for post-treatment infertility. 13 patients met the inclusion criteria and were enrolled in the study. After successful treatment and recovery, cryopreserved ovarian tissue was thawed and autotransplanted in three cases. The ultrathin slices of ovarian cortex were transplanted on the remaining ovaries with laparoscopic or minilaparotomic intervention. Patients were discharged home after an uneventful postoperative period and are followed up currently. In summary, cryopreservation and autotransplantation of ovarian tissue is a safe technology for fertility preservation, which should be considered to offer and perform prior to gonadotoxic treatment, after individual evaluation of patients

S0019 Opioid Dependence and Outcomes in Total Pancreatectomy With Islet Autotransplantation in Patients With Chronic Pancreatitis

INTRODUCTION: Total pancreatectomy with islet autotransplantation (TPIAT) is a surgical option for patients living with chronic pancreatitis. Many of these patients are dependent on chronic opioid therapy prior to surgery and we therefore studied the outcomes of these patients in comparison to non-opioid users using a national inpatient database. METHODS: The National Inpatient Sample (NIS) is the largest all-payer inpatient database in the United States. Data from the years 2008 to 2014 were collected. Patients older than 18 years with an admission diagnosis of chronic pancreatitis and who underwent total pancreatectomy with islet autotransplantation were included. Mortality, length of stay, and cost of hospitalization were measured amongst patients that were opioid dependent and those who were not. RESULTS: Between 2008 and 2014, there were 990 patients older than 18 years with chronic pancreatitis that underwent TPIAT. A total of 67 patients had a diagnosis of opioid abuse or dependence. Baseline patient demographics and hospital characteristics is available in Table 1. The majority of patients that underwent TPIAT were women in both groups. Surprisingly the majority of opioid dependence patients that underwent TPIAT were on the western part of the US and none were in the Midwest or Northeast. There was a total of two deaths in the non-opioid abuse group and none in the opioid group though this was not statistically significant. Length of stay (median 12 days vs. 11 days, P = 0.62) and cost of hospitalization ($68,938 vs. $60,412, P = 0.25) was higher in patients without opioid abuse but these outcomes were not statistically significant.Figure 1CONCLUSION: Opioid dependence does not seem to play a major role in some outcomes of TPIAT patients during their incident admission for surgery based on our data. However, this retrospective study does not give us long term outcomes of these patients and therefore prospective studies will need to be investigated to make the appropriate choices.

Effect of Orthodontic Treatment on Tooth Autotransplantation: Systematic Review of Controlled Clinical Trials.

This systematic review was focused on evaluating tooth autotransplantation, considering its impacts on the teeth, bone, soft tissues, and aesthetics in orthodontic patients. A bibliographic search was conducted without limitations on year of publication or language in the databases of PubMed, Web of Science, Scopus, Medline Complete, Cochrane, Clinical Trials, and Trials Central. For triage of articles, indications, surgical planning, orthodontic movement, risk factors for treatment, and long-term follow-ups were considered. For outcomes, the results with reference to teeth, alveolar bone, periodontal tissues, and esthetic satisfaction were considered. Risk of bias was evaluated using the methodological index for nonrandomized studies-MINORS. The results showed 10 controlled clinical trials, and no randomized clinical trials were found. The selected studies included 715 patients and 934 autotransplanted teeth among which there were premolars, molars, and anterior teeth evaluated in the long term, indicating that orthodontics associated with autotransplantation indicated a result that was generally clinically acceptable. The quality of the set of evidence was considered medium due to the presence of different methodological problems, risk of bias, and significant heterogeneity in the evaluated studies. There was a sufficient body of evidence that justified autotransplantation in patients who needed orthodontic movement. In teeth, there was an increase in root resorption influenced by orthodontics, but without impacting on the general clinical result in the long term. Bone and periodontal tissue do not appear to be affected by orthodontics. The patient’s aesthetic satisfaction was not considered in the studies.

Risk factors predicting severe hypocalcemia after total parathyroidectomy without autotransplantation in patients with secondary hyperparathyroidism.

ObjectiveThis study was performed to investigate the risk factors for severe hypocalcemia (SH) after total parathyroidectomy without autotransplantation (TPTX) in patients with secondary hyperparathyroidism.MethodsWe retrospectively analyzed the records of 136 patients with secondary hyperparathyroidism treated by TPTX. The patients were categorized as having SH or non-SH based on their postoperative blood calcium concentration. The risk factors for SH were identified by comparing the clinical characteristics between the two groups and by performing multiple logistic regression analyses.ResultsAfter surgery, 46.0% of the patients had hypocalcemia and 31.7% had SH. Evidence of renal osteodystrophy on lumbar radiographs and the serum concentrations of intact parathyroid hormone (iPTH), calcium, and alkaline phosphatase (ALP) were different between the two groups. The SH group had higher preoperative iPTH and ALP concentrations than the non-SH group. In addition, more patients with SH showed renal osteodystrophy. Logistic regression analyses indicated that preoperative hypocalcemia and a high ALP concentration were independent predictors of SH.ConclusionPreoperative hypocalcemia and a high ALP concentration were identified as risk factors for SH following TPTX.